The purpose of this career development award is to support Dr. Zingmond in establishing a career in improving the quality of geriatric care. Dr. Zingmond's overall goal is to examine the medical and nursing processes of care among older individuals receiving institutional and home-based long-term care and in turn, how these processes of care can be related to primary and secondary measures of outcome. This process-oriented approach extends prior work in quality of long-term care that has focused primarily on outcomes-based performance measures. Yet, outcomes do not pinpoint what to do and a lack of adverse events does not necessarily indicate good care. Evaluation of long-term care quality is still in its infancy in part due to the poorer general health of these patients, the complex nature of the goals and outcomes of care, and the lack of routinely collected measures of patient health, care received, or outcomes relevant to long-term care. It is important to understand (1) how patient and provider characteristics affect patient care, (2) how care processes can be measured and related with patient outcomes, and (3) which processes are effective in reducing undesired outcomes across the spectrum of long-term care, from home-based care to nursing home care. The proposed research has 3 aims that will form the basis for Dr. Zingmond's future work. In summary, the specific aims of this mentored career development award are to: 1. Adapt consensus expert quality indicators of processes of care for individuals receiving (a) homebased or (b) institutional long-term care to administrative data; And Characterize the quality of long-term care delivered to patients in California. 2. Examine the impact of process of care on maintaining function, preventing over-utilization, and decreasing mortality among nursing home recipients. 3. Examine the impact of process of care on maintaining independence and function, preventing over-utilization, and decreasing mortality among home care recipients.